VSAT, Networking, LAN/WAN, Consultancy

Application Information
Select your company type Customer Representative Partner Associate Partner
Legal Entity Name
Target name if different from registered Name
Registration Detials of the Legal Entity
Registration Number
Country and City of Registration
Full names and surnames of any directors, owners, partners or shareholders
Name	Position	% Ownership





Application Contact Details
Business Postal Address
Business Physical Address
Primary Contact Details
Title
Name
Telephone
Fax
Email
Mobile
Staff Complement, including number of sales staff
Designation	No. of Staff	% Training & Experience
Management
Technical Support
Network Operations Centre
Call Centre
Sales
Provide a brief overview of the service you currently offer
Licensing
Do you currently install and/or support any VSAT, IT or Telecommunication or networks?	Yes No Please provide a brief description
Do you currently have access to a license/s that will govern the provision of VSAT services in your proposed territory	Yes No Please provide a brief description
What Proposed Territory is application being made for?	Country/ies
	Town(s)/City(ies)/Region(s)
Conclusion and Motivation
Motivate why SurfCom should approve and authorise you as a Representative in the proposed territory.